PERSONAL ASSISTANCE SERVICES - THE HUB OF THE POLICY WHEEL FOR COMMUNITY INTEGRATION OF PEOPLE WITH SEVERE PHYSICAL-DISABILITIES

The success of persons with severe physical disabilities in living ind ependently in the community, engaging in self-directed productive acti vities, and staying healthy depends, in part, on getting and maintaini ng adequate personal assistance with basic tasks such as getting out o f bed and tending to personal hygiene. Although few policymakers would disagree with the contention thal many people with disabilities need assistance with daily tasks, there is considerable debate about who sh ould provide assistance, what services should be included, who should pay, who should be entitled to publicly provided and paid services, ho w much assistance should be provided, and who should control its admin istration. The prevailing model for delivery of personal assistance se rvices has been primarily medical, with control of services by health care professionals, rather than independent living, with control by co nsumers receiving services. Traditionally there has been an institutio nal bias of funding for disability-related service, despite its much h igher expense than community-based personal assistance services and it s violation of basic human rights. Proponents of various solutions to health care reform have given little consideration to the provision of support services for people with disabilities. The advantages of impl ementing a uniform national system for the delivery of personal assist ance services based on consumer control are discussed.